Cryptococcosis: Population-based multistate active surveillance and risk factors in human immunodeficiency virus-infected persons

To determine the incidence of cryptococcosis and its risk factors among hum an immunodeficiency virus (HIV)-infected persons, population-based active s urveillance was conducted in four US areas (population, 12.5 million) durin g 1992-1994, and a case-control study was done. Of 1083 cases, 931 (86%) oc curred in HIV-infected persons, The annual incidence of cryptococcosis per 1000 among persons living with AIDS ranged from 17 (San Francisco, 1994) to 66 (Atlanta, 1992) and decreased significantly in these cities during 1992 -1994, Among non-HIV-infected persons, the annual incidence of cryptococcos is ranged from 0.2 to 0.9/100,000. Multivariate analysis of the case-contro l study (158 cases and 423 controls) revealed smoking and outdoor occupatio ns to be significantly associated with an increased risk of cryptococcosis; receiving fluconazole within 3 months before enrollment was associated wit h a decreased risk for cryptococcosis. Further studies are needed to better describe persons with AIDS currently developing cryptococcosis in the era of highly active antiretroviral therapy.